The present invention relates generally to a system and method for cerebral shunt placement and, more particularly, to a cranial cover including a base plate and a guide for holding a catheter after ultrasound guided cerebral shunt placement.
Hydrocephalus, otherwise known as “water on the brain”, is a condition in which the ventricles of the brain, which typically maintains a steady balance of daily production and reabsorption of cerebrospinal fluid (CSF), fail and an excess amount of CSF accumulates. Various, either chronic or acute, conditions may cause this condition due to a lack of sufficient drainage. Known treatment of hydrocephalus may include placing a shunt into a ventricle to drain the excess fluid.
Recent treatment methods may utilize ultrasound visualization, a real-time imaging system, to increase the accuracy of shunt placement. In a typical procedure, shunt placement is achieved by drilling a relatively large diameter (e.g. 12 mm) burr hole into the skull and grinding away extra bone in one area to provide clearance for the catheter to be guided along the ultrasound device. Further complications may develop if this device is not accurately placed, including leakage around the catheter, hemorrhaging, migration of the catheter, and/or infection.
Two of the largest problems observed with cerebral shunt placement is shunt 1) obstruction which can be seen from catheter migration, and 2) infection which can be seen from pseudomeningocele formation at the burr hole site. Currently, there are no known cranial covers configured to both cover the burr hole, and firmly hold a catheter in a desired orientation.
Complications due to shunt placement can arise that are largely contributed to ultrasound guidance techniques. For example, infections may be partly due to the larger burr hole required to place the ultrasound device on the dura mater underneath the bone. In order to help prevent infection, a cranial plate would be able to cover the hole and decrease the exchange of fluids from the brain with the surrounding tissue. By developing a plate to cover the burr hole, the shunt infection rate in patients can be decreased, thus decreasing hospital visits, postoperative complications, and the number of shunt revision surgeries.
In certain patients with ultrasound guided cerebral shunt placements, pseudomeningocele (an abnormal collection of CSF around the brain) occurs, with some cases having the collection of fluid protrude out of the surface of the skull. This complication could be directly solved with the installation of a plate to prevent the fluid sack from protruding out. Along with preventing protrusions, the plate will act like a barrier preventing any external objects from entering the burr hole.
According to an illustrative embodiment of the present disclosure, a cranial cover is configured to be secured to a skull, and to cooperate with a catheter extending within a burr hole formed within the skull. The cranial cover includes a base plate having an upper surface, a lower surface, and an opening extending through the base plate between the upper surface and the lower surface. A guide extends upwardly from the upper surface of the base plate and includes a first riser, a second riser, and a receiver defined between the first riser and the second riser. A holder is supported by the first riser and the second riser and is configured to retain a distal portion of the catheter within the receiver and extending parallel to the upper surface of the base plate. A support boss extends downwardly from the lower surface of the base plate and is configured to be received within the burr hole.
According to another illustrative embodiment of the present disclosure, a ventricular catheter assembly includes a proximal catheter configured to be in fluid communication with a ventricle of a brain and to extend through a burr hole formed within a skull receiving the brain. A cranial cover cooperates with the proximal catheter. The cranial cover includes a base plate having an upper surface, a lower surface, and an opening extending through the base plate between the upper surface and the lower surface. A guide extends upwardly from the upper surface of the base plate and receives the proximal catheter for extending parallel to the upper surface of the base plate. The guide maintains the catheter angle entering the skull and reduces catheter migration.
According to a further illustrative embodiment of the present disclosure, a method of treating hydrocephalus includes the steps of forming a burr hole within the skull of a person, placing a proximal catheter in fluid communication with a ventricle of a brain within the skull, and positioning a cranial cover external to the skull. The cranial cover includes a base plate having an opening, and a guide supported by the base plate. The method further includes the steps of the aligning of the opening of the base plate with the burr hole in the skull, securing the base plate of the cranial cover to the skull, positioning the proximal catheter within the guide parallel to an outer surface of the skull, and securing the proximal catheter within the guide.
In certain illustrative embodiments of the present disclosure, the base plate may be produced in different materials allowing for either permanent placement or temporary placement (e.g., resorbable).
Additional features and advantages of the present invention will become apparent to those skilled in the art upon consideration of the following detailed description of the illustrative embodiments exemplifying the best mode of carrying out the invention as presently perceived.